I am probably going to get a lot of negative feedback from this second installment. I want to talk about underperforming hygiene departments. Pretty much 90% of the offices I see fit this description. Whether you have one or a dozen hygienists you need to look at hygiene as the hub of your entire practice. They should be bringing in at least 33% of your entire office production. They should partner with you to help patients want what they need while building up their doctor’s image in the mind of the patient. Cleaning teeth is the last thing on the list of important functions that hygienists perform. I will assume that all of us have great “teeth cleaners” but that should be a given. If you, like many others, find your hygienist thinking her job is just cleaning teeth, you definitely will be challenged to grow your practice. This is what we need to address to create the proper culture and understanding of what a super productive hygiene department is and how it should perform.
So how do we reset the image that many hygienists have of their role in our practices? How do we elevate the importance of their part in a successful practice? How can we create incentives and consequences to ensure their growth and engagement in the business of dentistry, while not having them act like a privileged prima donna where the world revolves around them? Why would this ever happen?
Failure or falling short of the ideal in your hygiene department is the result of “no pain”. We are all familiar with the phrase: “no pain, no gain”. When you work out, that leg exercise, if done correctly and consistently, is going to hurt in a couple of days. Striving and straining increases the likelihood of physical gain. Should it be any surprise that anything worth striving for is up hill? The pain of putting off gratification in order to succeed in life has become a worthy goal. When I say, “no pain” here is what I am talking about. If you pay your hygienist hourly you have created a one-sided accountability formula for mediocrity. Hygienists that are paid hourly do not feel the “pain” of:
- Cancellations and No-Shows: When someone does not show up for their appointment or cancels at the last minute, an hourly employee has no skin in the game. They feel no pain. They get paid whether they produce or not. Especially if that hygienist feels that making recall calls, reactivation efforts, or cleaning up a room for a busy assistant is beneath the station of an educated, degreed hygienist. Most good hygienists are more than willing to pitch in and help the team, but most good hygienists also should be responsible for their schedule by anticipating recidivistic no showers, and late shows. They should constantly follow their own schedules so that they are productive every minute of the day regardless of the circumstances. Your hygienist must be engaged to the point that they will not tolerate anything less than a 90%+ utilization each and every day. An ownership mentality can only be achieved when an employee feels the sting of failure.
- Few if any Scaling and Root Planing appointments: The number one indicator of a poorly trained hygienist and a marginal standard for clinical excellence in your dental office is having anything less than 20% of your patients needing Periodontal procedures. Hourly hygienists don’t feel the pain when they fail to keep up with technology, clinical excellence, and patient education. They get the same pay regardless of whether or not they continue to learn and care for their patients at the highest standard of care. It’s only human nature not to strive if there are no consequences to just being average.
- Poor hygiene recall: This falls squarely on the heads of hygienist as they interact with their patients. 100% of patients should be scheduled for future appointments for cleanings and exams. The sad truth is that the national average is 41%. We spend all this money on marketing to attract new patients and yet fail to maximize our return on our current patient load by not continually and consistently caring for those already in the practice. Check for yourself. You will be horrified at what you see. If you did not do this last week, here is one more chance to accept the responsibility of measuring where you are and making you and your staff accountable for your results. When you get rid of your excuses, you will find your results. Just look out 3 or 4 months on hygiene in your schedule and see what you find. Most of the time you will see 3 or 4 patients scheduled and those are all early in the morning or late in the afternoon. The very times that new patients will demand. Not only are they not pre-appointing their current patients, but they have undermined the front desk by not guarding the peak demand times that new patients will want. Poor recall happens when there is no pain. NOTE: Don’t just ask them, go and look and see for yourself what it really looks like.
- Weather: How many times have you made it to work only to find that only one or two employees show up, and none of the hygienists? If you pay hygienists by the hour, there is no pain or at least not enough to get them to try and make it to work. No pain, no gain.
- Poor production per hour in hygiene: Being paid hourly allows you to stop looking at your own productivity because you make the same regardless of the day. The office takes all of the risk while the hourly hygienist takes home an hourly wage. The reality of business is that systems that encourage mediocrity should be challenged. Hygienists and doctors are the only people who can control their productivity by improving their efficiencies and effectiveness. Hourly pay encourages an hourly appointment. No one needs an hour to have his or her teeth cleaned. They may need 70 minutes, 49, 51, but no one needs exactly 60 minutes. So why is every office scheduling exactly 60 minutes for every recall. Go to commission and magically all of this garbage scheduling goes away.
- If you don’t measure a hygienist results: What is measured, gets done. That is why policy manuals, job descriptions and benchmarks for every position are so important. They create a black and white scorecard for excellence. We measured the hygienist’s production per week, the number of scaling and root planings they did per week, and the number of crowns they presented per week. This was kept on a graph posted in the staff area where everyone could see. The hygienist was tasked with keeping this up to date weekly. While their job descriptions may have dozens of other requirements, these three areas, if done well, will insure a super productive hygiene department that will continue to grow while offering the hygienist an ability to improve what they are paid in a commission based or hybrid pay system.
While we could probably add a few more areas where there is no pain in an hourly based pay scheme, I think you can see how consequences create an accountability that drives hygienists to re-engage in their jobs while understanding the Business of Dentistry. This is how you Summit.
Michael Abernathy, DDS